Obviously, patients don’t like the idea of chemotherapy or the toxicities; those are meaningful for patients. On the other hand, when you can cure a substantial fraction of patients as we do in large cell lymphoma, it is hard to “throw the baby out with the bathwater,” so to speak.
What data are you anticipating at the 2017 ASCO Annual Meeting?
In hematologic malignancies, the data that have been most exciting and we will follow up with is treatment with ibrutinib (Imbruvica) for [patients with] chronic lymphocytic leukemia. We will see more targeted therapies in leukemia, and more follow-up data with bendamustine studies in indolent lymphoma. Because there are so many meetings these days, we get to see the incremental advancements.
There were exciting data at ASH about rituximab maintenance therapy in mantle cell lymphoma (MCL). Is that a viable strategy for treating those patients?
Maintenance therapy with rituximab has shown benefit in MCL after CHOP or R-CHOP therapy. It has also shown benefit after an autologous stem cell transplant, where it’s provided not only a progression-free survival benefit but also an overall survival benefit. It has not been quite as well established after bendamustine-based therapy, which is the most common therapy, at least for older patients.
We have an ECOG intergroup 4-arm study that is looking at bendamustine and rituximab with a variation on that, which includes adding bortezomib (Velcade) as an induction therapy, and adding rituximab or rituximab and lenalidomide as 1 of the maintenance therapies. It may be a while until we have that data, since patients tend to do well on that. Ultimately, I do think rituximab maintenance has a clear value in treating MCL, and it wouldn’t surprise me if adding lenalidomide or some other novel agents over time also makes a difference.
What do you find to be some of the exciting developments in MCL lately?
In MCL, ibrutinib has made a big difference for patients. We are learning more about sub-classifying the MCL population, and the future is going to have more combinations with ibrutinib, whether it’s venetoclax (Venclexta), or cell cycle inhibitors, or other novel compounds to try to minimize or treat resistance as well as extend the duration of remission.